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Documentos de Cultura
Study the wall of the trunk and mark the boundaries between thorax and
abdomen. Use the skeleton for this if necessary.
Where is the liver and the spleen in relation to the ribs (upper and lower
border)?
Remember the practicum bodypaint from the first year.
At which places could you safely bring in a thorax drain?
At which places could you safely do a punction of the pericard? In what
cases would that be necessary?
At which place do you project the bifurcation aortae? So where could you
palpate an AAA?
Where is the ligament of Poupart? Which tendon (aponeurose) is it part of?
Where is the point of McBurney? Localize on the body the place where the
incisions are made for a correction of an inguinal hernia, appendectomy, a
small incision cholecystectomy, median laparotomy, Pfannenstiel,
nefrectomy and a clamshell incision. What sort inciscions should,
cosmetically seen, be preferred?
In this dissection you can also see the course of the arteria epigastrica
inferior. To which arteries is it connected?
Name and localize the four muscle of the abdominal wall. Describe the
course of the fibres. How are these muscles vascularized and innervated?
Study the course of the musculus rectus abdominis. What is a intersection
tendinae? How is the rectus sheath formed?
What is the linea arcuata and where can you localize it. What is the course
of the plates of fascia cranial and caudal of this line?
Between which layers of the abdominal wall (but also the thoracic wall), go
the vessels and the nerves that vascularise and innervate the abdominal
wall (and skin)?
Look at the nuscuki pectoralis major and minor. Name the origin and
insertion and discuss the function.
You can also see the funiculus permaticus (spermatic cord) in this
dissection. Which structures go through here?
o Palpate the ductus deferens
Study the position of the mamma on the fascia of the musculus pectoralis
major. Localize the origo and insertion of this muscle. What is the function?
Do the same for the m. pectoralis minor.
Name and localize the boundaries of the fosa axillaris as it is used in a
lymph node dissection of the axilla. What is the posterior and anterior
axillary fold?
Try to localize the lymph node stations of the mamma in the fossa axillaris.
Where could the sentinel node be? In what ways do we find the sentinel
node if it has to be removed?
Name the three groups (levels) lymph nodes in this area. Which are
removed in a dissection of a mammaca? Which is possible in a melanoma
on the arm.
Which three important nerves (and the blood vessels that run with it) can
you name in the fossa? Which structures do they innervate? Which can
sometimes not be spared during a lymph node dissection in this area and
which complaints can this give postoperatively?
Discuss (with your teacher if necessary), using the dissection, how a
sentinel node is removed and how a modificated radical mastectomy is
executed?
Table 5: Groin from the inside HEUN 223 and HEUN 224
In these two dissections you can study the inguinal canal and its surroundings
from the inside.
Dissection A.
Put this dissection upright (on its legs) so you can look into it.
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Dissection B.
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Identify:
o The ligamentum inguinale
o The internal and external annulus inguinalis
o The testicular vessels
o The ductus deferens
Localize the marks of the border between a medial and lateral inguinal
hernia.
How can an urologist or a general practitioner do a vasectomy in an easy
way?
Where do you localize a hernia femoralis?
CKO 3, PR day 2
Table 1: Upper abdomen, superficial
Projection organs on the abdominal skin.
Superficial dissection of the abdomen. This is a so called hooded dissection. In
other words: the complete anterior abdominal (and thoracic) wall is removed to
give you an optimal view. Do realize that the surgical access is often via a median
laparotomy, there the overview is obviously less optimal.
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Determine where the bursa omentalis is and name the boundaries of the
bursa.
o At the ventral side
o At the dorsal side
o The caudal boundary
o Left from the bursa lies.
o Right is
Localize the foramen of Winslow and the ligamentum hepatoduodenale.
o Which three structures go through the ligament and localize them in
the dissection.
o What is the Pringle maneuver?
By which structures is the triangle of Calot formed?
o Localize and name the gall ducts in the dissection, as far as they are
visible.
o What do we understand under the syndrome of Mirizzi? Show it in
the dissection.
How would you remove the gall bladder and which important complication
would you have to prevent? Think also of the anatomic variations.
Localize the truncus coeliacus.
o Name the branches of the truncus and localize them as far as they
are visible.
In the SSA you have already studied the side branches of the abdominal
aorta. Name and localize again all the side braches and their
vascularisation area till the ligament of Poupart, using the dissection. Think
again of the unpaired ventral and the paired lateral branches.
o Three ventral unpaired branches. What is their vascularisation area?
o The lateral paired branches. Do they lie retroperitoneal?
o Look at the relations/distances between the branches of the kidney
arteries, the gonadal arteries, the truncus coeliacus and the arteria
mesenterica superior.
Which two manifestations (in general, not necessarily for this dissection) of
atherosclerosis in this area of the abdominal aorta are there? What could
theoretically be the treatment of each of the two abnormalities?
Study the position of the aorta in the area of the kidney arteries. An
aneurysm of the aorta can be treated with an endovascular stent in some
cases. In a case like that, what and why would you want to know about the
position and length of the aneurysm? In other words, when is such a stent
treatment possible and when not?
Localize both ureters again.
This body has a stoma left in the lower abdomen. Remove the hood.
This body (this former patient) might have had a Hartmann procedure.
What is meant by this?
o At which part has this (terminal) stoma been made? Can you still
find the stump of the rectum?
o If not, which operation would this patient have had then?
In this dissection a resection has been done (by us, post mortem).
o Which resection has been done?
o What kind of anastomosis has been made?
o What other anastomoses are there?
There are other resections possible. Of the following procedures, the
questions are again and again:
o Which part will be removed
o Where are the cutting edges?
A hemicolectomy on the right
A hemicolectomy on the left
An anterior resection
A low anterior resection
What is a terminal stoma, a double barrel stoma, what is
meant by term such as an afferent loop and efferent loop.
Now put back the hood in its place for the next group!
CKO 3 PR dag 3
Table 1. Shoulder, arm.
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Name the bone parts of the upper extremity, use the skeleton for this.
Where is the (only) joint connection with the trunk situated?
Repeat the knowledge on the five most important nerves that come out of
the plexus brachialis using both dissections.
o Which five nerves are meant and try to localize them in the
dissection.
o What is the global course of each nerve? Use the skeleton again.
o Which muscle groups are innervated by these nervi?
o Localize the aforementioned muscle groups.
What is the further course of the arteria subclavia in the arm to the hand
called? Localize this in the dissection.
o Where goes the arcus Palmaris?
o For which operation do you need to have knowledge on this arcus as
a preparation?
How do you explain the loss of sensibility in the area of the lateral
shoulder/upper arm due to a luxation of the shoulder?
Patient B, a nine-year old girl, falls out of the climbing rack on the square
in front of the house on a Sunday afternoon. She has a lot of pain in her left
arm and she has to cry a lot. Due to a calm anamnesis of the medical
student at the first aid she is able to tell that most of the pain is near her
elbow. There is an obvious swelling and function laesa.
o
What is the most probable diagnosis of this injury and what is the
treatment.
Patient C, a 3-year old girl was lifted up by her hands by her parents
and was swung forward and backwards as a game. It was a sweet and
kind gesture, but immediately the girl had pain in her left elbow (side of
the father) and she did not want to use her left arm anymore. During
physical examination the arm stands at 90 degrees. There is no
swelling, but there is function laesa.
o
Study the deeper muscle groups of the fore-arm in the model and the
dissections.
Which muscles are involved in supination and pronation. Study these
muscles with their origo and insertion. Try to localize them in the
dissection.
Study, by using the dissections, by which structures the tabatiere
anatomique is formend. Also use your own wrist for this.
At the volair side of the wrist run a couple of tendons (..) and muscles.
Study them using the dissections and try if you can find them in your own
wrist.
Where is the carpal tunnel? How is this formed? What is the CTS? What is
the diagnosis and treatment.
Study and name the part of the skeleton at the pelvis and upper leg.
Localize the muscle groups around the hip and those of the upper leg in
the model and the dissections.
By which nervi are these groups innervated?
o What is the course of these nerves?
o What is a meralgia paresthetica?
Case
Patient F, a 53-year old woman, felt a sudden pain in her right calf during her
monthly tennis game, like someone struck her from behind with a racket. She
also thought she heard some kind of snap. She complains about pain, but not
severely so, in her right calf and she also walks a little crippled, according to her
story.
o
Patient G, a 34-year old woman, wanted to walk up the stairs quickly and took
of with her right leg. She felt a sudden severe pain in her right calf. Walking hurts
and she thinks that she has notices a swelling in her calf.
o
Name and localize in the dissection the vessels of the arterial system
starting from the bifurcation aortae to the foot. The structures are all
labelled with thread.
Name also the same arteries in the accompanying angiogram.
At which places can you palpate the arteries during you physical
examination?
Which treatment options are there in theory (3) for a patient with a severe
claudication intermittens and a complete obstruction at the beginning of
the arteria femoralis superficialis, (so just after the bifurcation with the
arteria femoralis profunda)?
What is meant with a fem-fem crossover bypass?
What is an axillobifemoral bypass? In which case could this be necessary?